Wednesday, August 06, 2008

One of my heroes

Have a look at this interview with Richard Feynman, Noble Prize Winner and guru of theoretical physics. He is definitely one of my heroes. Here he talks about Social Sciences. He might as well have talked about the general status in stuttering research!

Also, check out his superb explanation of what science is about using chess!

5 comments:

As I listen and apply what Feynman says to the "research" that is being engaged in by "experts" in stuttering - and the "professional" organizations of these "experts" in stuttering - I completely endorse the idea that the "experts" most used -- and effective -- tactic for "ABSOLUTING" their "research" is always intimidation. The majority of them - through my stuttering eyes - don't know jack****. The current body of "expert researchers in stuttering" are better off being viewed as comedians. (You know, total jokes. ;-) ! )

Unfortunately, the majority of we who stutter are easily intimidated by the "experts" and their "professional" organizations.

Well done with the clip of Dr. Feynman. While the video is entertaining, a more fulfilling reference to Dr. Feynman and more applicable to stuttering would be a link to his commencement address to Caltech, “Cargo Cult Science,” which is published in “Surely you’re joking Mr. Feynman” and available on the Internet. Focusing on medication for stuttering, discussion on this blog and many other contemporary forums for the layperson lacks acknowledgement of previous pharmacologic findings, such as the work of Dr. Shapiro in his research in Tourette Syndrome, which is the framework that medications have been used in stuttering. An appreciation and of the past 50 years or so of pharmacologic study would help illuminate current studies of medication and give the readers of this blog an understanding of the lukewarm response professionals have had to the pagoclone studies that are mentioned on this blog.

That the preliminary studies of pagoclone are mentioned so prevalently on this blog is perplexing and in contrast to what is contemplated professionally. An interesting post, that may be within the rubric of Tom’s experience in finance, would be a narrative outlining the financial contributions to researchers and institutions involved in pagoclone and stuttering. Nathan E. Lavid, MD

I mention Pagoclone, because I constantly get emails from my readers on Pagoclone. And because it is the largest random control study so far. So it is interesting. I'll keep an open mind to whether it will be beneficial or not.

I am not concerned about financial contributions by companies as long as the trials are objective. And there is no lobbying for the drug so far, so I'll wait until that happens.

Again, I like the posting of Dr. Feynman’s interview. His work, adventures, and scientific integrity are inspiring and fit in well with the work you’ve done on this blog.

I mentioned his Cargo Cult Science address as a caveat to the clinical limitations of the pagoclone work. And, the readers of this blog interested in pagoclone would be better informed with discussions addressing these limitations. As a clinician, I’ll mention some of my concerns. While this is the largest study of a medication in stuttering, the findings at this stage as a Phase II study, inherently, have limited power. The findings are further limited by the lack of an outcome standard. There is no consensus on which type of outcome measure, such as self report, 3rd party assessment, clinician assessment, i.e., CGI or a psychometric instrument, i.e., the SSI-3 is best. The pagoclone studies have used a number of measures and it’s hard to determine an outcome when so many lines are drawn in the sand, so to speak.

Moreover, there is potential for financial influences in small studies that are industry sponsored. It is established that there is a bias in favor of medications that are sponsored by drug companies, and it would be helpful to know how Indevus allocated funding for this work.

On a positive note, that Indevus is progressing to Phase III studies and seeking FDA approval will address some of my concerns. To gain FDA approval, more patients, researchers, and facilities will be used, adding to the power and validity of the work. It will be interesting to find out what the FDA determines is an acceptable outcome and what is the appropriate measure for this outcome. This type of work was done with haloperidol in Tourette Syndrome many years ago, when the mechanism of action was not understood – similar to pagoclone now – and haloperidol was approved by the FDA for the condition. Nathan